Student s Last Name First Name MI Last 4 of SS# Verification Type: V1 V4 V5 Table of Contents Verification of 2015 Income Information for Student Tax Filers... 2 A 2015 IRS Tax Return Transcript may be obtained through:... 3 Individuals Who Filed an Amended IRS Income Tax Return... 3 Verification of 2015 Income Information for Individuals with Unusual Circumstances... 4 Individuals Who Filed Non-IRS Income Tax Returns... 5 Verification of 2015 Income Information for Student Nontax Filers... 6 Verification of 2015 Income Information for Parent Tax Filers... 7 Verification of 2015 Income Information for Parent Nontax Filers... 8 Number of Household Members and Number in College... 9 Receipt of SNAP Benefits... 9 High School Completion Status... 10 Identity and Statement of Educational Purpose... 11 Certifications and Signatures... 14 Verification Completed by Date: Verification Form Completed Page 1
Your 2017-18 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law says that before awarding Federal Student Aid, we must ask you to confirm the information you and your parents reported on the FAFSA. To verify that you provided correct information the financial aid administrator at your school will compare your FAFSA with the information on this worksheet and with any other required documents. If there are differences, your FASFA information may need to be corrected. FAFSA Verification must be completed before Pell can be awarded. Verification of 2015 Income Information for Student Tax Filers Important Note: The instructions below apply to the student and spouse, if the student is married. Notify the financial aid office if the student or spouse filed separate IRS income tax returns for 2015 or had a change in marital status after December 31, 2015. Instructions: Complete this section if the student and spouse filed or will file a 2015 IRS income tax return(s). The best way to verify income is by using the IRS Data Retrieval Tool (IRS DRT) that is part of FAFSA on the Web at FAFSA.gov. In most cases, no further documentation is needed to verify 2015 income information that was transferred into the student s FAFSA using the IRS DRT if that information was not changed by the FAFSA filer. Check the box that applies: The student has used the IRS DRT in FAFSA on the Web to transfer 2015 IRS income tax return information into the student s FAFSA. The student has not yet used the IRS DRT in FAFSA on the Web, but will use the tool to transfer 2015 IRS income tax return information into the student s FAFSA. The student is unable or chooses not to use the IRS DRT in FAFSA on the Web, and instead will provide the school with a 2015 IRS Tax Return Transcript(s). Page 2
A 2015 IRS Tax Return Transcript may be obtained through: Get Transcript by MAIL Go to www.irs.gov, under the Tools heading, click "Get a tax transcript. Click Get Transcript by MAIL. Make sure to request the IRS Tax Return Transcript and NOT the IRS Tax Account Transcript. Get Transcript ONLINE Go to www.irs.gov, under the Tools heading, click "Get a tax transcript." Click Get Transcript ONLINE. Make sure to request the IRS Tax Return Transcript and NOT the IRS Tax Account Transcript. Automated Telephone Request 1-800-908-9946 Paper Request Form IRS Form 4506T-EZ or IRS Form 4506-T In most cases, for electronic tax return filers, 2015 IRS income tax return information is available for the IRS DRT or the IRS Tax Return Transcript within 2 3 weeks after the 2015 electronic IRS income tax return has been accepted by the IRS. Generally, for filers of 2015 paper IRS income tax returns, the 2015 IRS income tax return information is available for the IRS DRT or the IRS Tax Return Transcript within 6 8 weeks after the 2015 paper IRS income tax return has been received by the IRS. Contact the financial aid office if more information is needed about using the IRS DRT or obtaining an IRS Tax Return Transcript. If the student and spouse filed separate 2015 IRS income tax returns, the IRS DRT cannot be used and the 2015 IRS Tax Return Transcript(s) must be provided for each. Individuals Who Filed an Amended IRS Income Tax Return An individual who filed an amended IRS income tax return for tax year 2015 must provide: A 2015 IRS Tax Return Transcript (that will only include information from the original tax return and does not have to be signed), or any other IRS tax transcript(s) that includes all of the income and tax information required to be verified; and A signed copy of the 2015 IRS Form 1040X, Amended U.S. Individual Income Tax Return, that was filed with the IRS. Check here if a 2015 IRS Tax Return Transcript(s) is provided. Check here if a 2015 IRS Tax Return Transcript(s) will be provided later. Check here if you have Unusual Circumstances like a Filing Extension, Amended Tax Return, Identity Theft, or non-irs tax return was filed. Additional paperwork will be required. Page 3
Verification of 2015 Income Information for Individuals with Unusual Circumstances Individuals Granted a Filing Extension by the IRS An individual who is required to file a 2015 IRS income tax return and has been granted a filing extension by the IRS, must provide: A copy of IRS Form 4868, Application for Automatic Extension of Time to File U.S. Individual Income Tax Return, that was filed with the IRS for tax year 2015; A copy of the IRS's approval of an extension beyond the automatic six-month extension if the individual requested an additional extension of the filing time for tax year 2015; Verification of Non-Filing Letter (confirmation that the tax return has not yet been filed) from the IRS or other relevant tax authority dated on or after October 1, 2016; A copy of IRS Form W 2 for each source of employment income received for tax year 2015 and, If self-employed, a signed statement certifying the amount of the individual s Adjusted Gross Income (AGI) and the U.S. income tax paid for tax year 2015. Individuals Who Were Victims of IRS Tax-Related Identity Theft An individual who was the victim of IRS tax-related identity theft must provide: A Tax Return Database View (TRDBV) transcript obtained from the IRS, or any other IRS tax transcript(s) that includes all of the income and tax information required to be verified; and A statement signed and dated by the tax filer indicating that he or she was a victim of IRS taxrelated identity theft and that the IRS is aware of the tax-related identity theft. Page 4
Individuals Who Filed Non-IRS Income Tax Returns A tax filer who filed an income tax return with Guam, the Commonwealth of the Northern Mariana Islands, the Commonwealth of Puerto Rico and the U.S. Virgin Islands may provide a signed copy of his or her income tax return that was filed with the relevant tax authority. However, if we question the accuracy of the information on the signed copy of the income tax return, the tax filer must provide us with a copy of the tax account information issued by the relevant tax authority before verification can be completed. A tax filer who filed an income tax return with the tax authority for American Samoa must provide a copy of his or her tax account information. A tax filer who filed an income tax return with tax authorities not mentioned above, i.e. a foreign tax authority, and who indicates that he or she is unable to obtain the tax account information free of charge, must provide documentation that the tax authority charges a fee to obtain that information, along with a signed copy of his or her income tax return that was filed with the relevant tax authority. Page 5
Verification of 2015 Income Information for Student Nontax Filers The instructions and certifications below apply to the student and spouse, if the student is married. Complete this section if the student and spouse will not file and are not required to file a 2015 income tax return with the IRS. Check the box that applies: The student and spouse were not employed and had no income earned from work in 2015. The student and/or spouse were employed in 2015 and have listed below the names of all employers, the amount earned from each employer in 2015, and whether an IRS W-2 form is provided. [Provide copies of all 2015 IRS W-2 forms issued to the student and spouse by their employers]. List every employer even if the employer did not issue an IRS W-2 form. If more space is needed, provide a separate page with the student s name and ID number at the top. Employer s Name IRS W-2 Annual Amount Provided? Earned in 2015 (Example) ABC s Auto Body Shop Yes $4,500.00 Total Amount of Income Earned From Work Provide documentation from the IRS or other relevant tax authority dated on or after October 1, 2016 that indicates a 2015 IRS income tax return was not filed with the IRS or other relevant tax authority. The student received additional support from the following: Page 6
Verification of 2015 Income Information for Parent Tax Filers Important Note: The instructions below apply to each parent included in the household. Notify the financial aid office if the parents filed separate IRS income tax returns for 2015 or had a change in marital status after December 31, 2015. Instructions: Complete this section if the parents filed or will file a 2015 IRS income tax return(s). The best way to verify income is by using the IRS Data Retrieval Tool (IRS DRT) that is part of FAFSA on the Web at FAFSA.gov. In most cases, no further documentation is needed to verify 2015 income information that was transferred into the student s FAFSA using the IRS DRT if that information was not changed by the FAFSA filer. Check the box that applies: The parents have used the IRS DRT in FAFSA on the Web to transfer 2015 IRS income tax return information into the student s FAFSA. The parents have not yet used the IRS DRT in FAFSA on the Web, but will use the tool to transfer 2015 IRS income tax return information into the student's FAFSA. The parents are unable or choose not to use the IRS DRT in FAFSA on the Web, and instead will provide the school with a 2015 IRS Tax Return Transcript(s). A 2015 IRS Tax Return Transcript may be obtained through: Get Transcript by MAIL Go to www.irs.gov, under the Tools heading, click "Get a tax Transcript. Click Get Transcript by MAIL. Make sure to request the IRS Tax Return Transcript and NOT the IRS Tax Account Transcript. Get Transcript ONLINE Go to www.irs.gov, under the Tools heading, click "Get a tax transcript." Click Get Transcript ONLINE. Make sure to request the IRS Tax Return Transcript and NOT the IRS Tax Account Transcript. Automated Telephone Request 1-800-908-9946 Paper Request Form IRS Form 4506T-EZ or IRS Form 4506-T In most cases, for electronic tax return filers, 2015 IRS income tax return information is available for the IRS DRT or the IRS Tax Return Transcript within 2 3 weeks after the 2015 electronic IRS income tax return has been accepted by the IRS. Generally, for filers of 2015 paper IRS income tax returns, the 2015 IRS income tax return information is available for the IRS DRT or the IRS Tax Return Transcript within 6 8 weeks after the 2015 paper IRS income tax return has been received by the IRS. Contact the financial aid office if more information is needed about using the IRS DRT or obtaining an IRS Tax Return Transcript. If the parents filed separate 2015 IRS income tax returns, the IRS DRT cannot be used and the 2015 IRS Tax Return Transcript(s) must be provided for each. Check here if a 2015 IRS Tax Return Transcript(s) is provided. Check here if a 2015 IRS Tax Return Transcript(s) will be provided later. Check here if you have Unusual Circumstances like a Filing Extension, Amended Tax Return, Identity Theft, or non-irs tax return was filed. Additional paperwork will be required. Page 7
Verification of 2015 Income Information for Parent Nontax Filers The instructions and certifications below apply to each parent included in the household. Complete this section if the parents will not file and are not required to file a 2015 income tax return with the IRS. Check the box that applies: Neither parent was employed, and neither had income earned from work in 2015. One or both parents were employed in 2015 and have listed below the names of all employers, the amount earned from each employer in 2015, and whether an IRS W-2 form is provided. [Provide copies of all 2015 IRS W-2 forms issued to the parents by their employers]. List every employer even if the employer did not issue an IRS W-2 form. If more space is needed, provide a separate page with the student s name and ID number at the top. Employer s Name IRS W-2 Annual Amount Provided? Earned in 2015 (Example) ABC s Auto Body Shop Yes $4,500.00 Total Amount of Income Earned From Work $ Provide documentation from the IRS or other relevant tax authority dated on or after October 1, 2016 that indicates a 2015 IRS income tax return was not filed with the IRS or other relevant tax authority. Check here if confirmation of nonfiling is provided. Check here if confirmation of nonfiling will be provided later. The parents received additional support from the following: Page 8
Number of Household Members and Number in College Number of Household Members: List below the people in the parents household. Include: The student. The parents (including a stepparent) even if the student doesn t live with the parents. The parents other children if the parents will provide more than half of the children s support from July 1, 2017, through June 30, 2018, or if the other children would be required to provide parental information if they were completing a FAFSA for 2017 2018. Include children who meet either of these standards, even if a child does not live with the parents. Other people if they now live with the parents and the parents provide more than half of the other person s support, and will continue to provide more than half of that person s support through June 30, 2018. Number in College: Include in the space below information about any household member who is, or will be, enrolled at least half time in a degree, diploma, or certificate program at an eligible postsecondary educational institution any time between July 1, 2017, and June 30, 2018, and include the name of the college. If more space is needed, provide a separate page with the student s name and ID number at the top. Full Name Age Relationship College Will be Enrolled at Least Half Time (Yes or No) Self Note: We may require additional documentation if we have reason to believe that the information regarding the household members enrolled in eligible postsecondary educational institutions is inaccurate. Receipt of SNAP Benefits Yes, a member of this household received SNAP benefits sometime during 2015, 2016, 2017. No SNAP benefits received. The parents certify that, a member of the parents household, received benefits from the Supplemental Nutrition Assistance Program (SNAP) sometime during 2015, 2016, 2017. SNAP may be known by another name in some states. For assistance in determining the name used in a state, please call 1-800-4FED-AID (1-800-433-3243). Page 9
High School Completion Status Provide one of the following documents to indicate the student s high school completion status when the student begins college in 2017 2018: A copy of the student s high school diploma. For students who completed secondary education in a foreign country, a copy of the secondary school leaving certificate or other similar document. A copy of the student s final official high school transcript that shows the date when the diploma was awarded. A state certificate or transcript received by a student after the student passed a State-authorized examination that the State recognizes as the equivalent of a high school diploma (GED test, HiSET, TASC, or other State-authorized examination). An academic transcript that indicates the student successfully completed at least a two-year program that is acceptable for full credit toward a bachelor s degree. For a student who was homeschooled in a state where state law requires the student to obtain a secondary school completion credential for homeschooling (other than a high school diploma or its recognized equivalent), a copy of that credential. For a student who was homeschooled in a state where state law does not require the student to obtain a secondary school completion credential for homeschooling (other than a high school diploma or its recognized equivalent), a transcript, or the equivalent, signed by the student's parent or guardian, that lists the secondary school courses the student completed and includes a statement that the student successfully completed a secondary school education in a homeschool setting. A student who is unable to obtain the documentation listed is ineligible for Financial Assistance. Page 10
Identity and Statement of Educational Purpose (To Be Signed at the Institution) The student must appear in person at Lively Technical Center to (Name of Postsecondary Educational Institution) verify his or her identity by presenting an unexpired valid government-issued photo identification (ID), such as, but not limited to, a driver s license, other state-issued ID, or passport. The institution will maintain a copy of the student s photo ID that is annotated by the institution with the date it was received and reviewed, and the name of the official at the institution authorized to receive and review the student s ID. In addition, the student must sign, in the presence of the institutional official, the Statement of Educational Purpose provided below. Statement of Educational Purpose I certify that I am the individual signing (Print Student s Name) this Statement of Educational Purpose and that the Federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of attending at Lively Technical Center for 2017-2018. (Name of Postsecondary Educational Institution) (Student s Signature) (Date) (Student s ID Number) (Financial Aid Officer Signature) (Date) Page 11
Verificación de Identidad y Declaración de Propósito Educativo (Para ser firmadas en la institución) El estudiante debe comparecer en persona en Lively Technical Center para (Nombre de la institución educativa postsecundaria) verificar su identidad mediante la presentación de una identificación con fotografía (ID) válida emitida por el gobierno que no haya expirado, como una licencia de conducir, otro tipo de identificación emitida por el estado o pasaporte, entre otros. La institución conservará una copia de la identificación con fotografía del estudiante en la cual se anotará la fecha en la que se recibió y revisó, y el nombre del funcionario de la institución autorizado a recibir y revisar las identificaciones de los estudiantes. Además, el estudiante debe firmar, en presencia del funcionario de la institución, la Declaración de Propósito Educativo proporcionada a continuación. Verificación de Identidad y Declaración de Propósito Educativo (Para ser firmadas en presencia de un notario) Si el estudiante no es capaz de comparecer en persona en (Nombre de la institución educativa postsecundaria) para verificar su identidad, el mismo debe proporcionar a la institución: (a) una copia de la de identificación con fotografía (ID) válida emitida por el gobierno que no haya expirado, que se reconoce en la declaración del notario que aparece a continuación, o que se presenta ante un notario, como una licencia de conducir, otro tipo de identificación emitida por el estado o pasaporte, entre otros; y (b) la Declaración de Propósito Educativo original proporcionada a continuación debe ser notarizada. Si la declaración del notario aparece en una página separada de la Declaración de Propósito Educativo, se debe indicar de manera clara que la Declaración de Propósito Educativo era el documento notarizado. Declaración de Propósito Educativo Certifico que yo,, soy el individuo que firma esta [Imprimir nombre del estudiante] Declaración de Propósito Educativo, y que la ayuda financiera federal estudiantil que yo pueda recibir sólo será utilizada para fines educativos y para pagar el costo de asistir a para 2017 2018. [Imprimir nombre de institución educativa postsecundaria] [Firma del estudiante] [Fecha] [Número de identificación del estudiante] Page 12
Identity and Statement of Educational Purpose (To Be Signed in the Presence of a Notary) If the student is unable to appear in person at Lively Technical Center (Name of Postsecondary Educational Institution) to verify his or her identity, the student must provide to the institution: (a) A copy of the unexpired valid government-issued photo identification (ID) that is acknowledged in the notary statement below, or that is presented to a notary, such as, but not limited to, a driver s license, other state-issued ID, or passport; and (b) The original Statement of Educational Purpose provided below, which must be notarized. If the notary statement appears on a separate page than the Statement of Educational Purpose, there must be a clear indication that the Statement of Educational Purpose was the document notarized. Statement of Educational Purpose I certify that I am the individual signing this Statement of Educational (Print Student s Name) Purpose and that the Federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of attending for 2017 2018. (Name of Postsecondary Educational Institution) (Student s Signature) (Date) (Student s ID Number) STATE OF FLORIDA COUNTY OF Notary s Certificate of Acknowledgement The foregoing instrument was acknowledged before me this day of 20, by (name of person acknowledging.) (Seal) Signature of Notary Public Print, Type/Stamp Name of Notary Personally known: OR Produced Identification: Type of Identification Produced: Page 13
Certifications and Signatures Each person signing below certifies that all of the information reported is complete and correct. The student and one parent whose information was reported on the FAFSA must sign and date. WARNING: If you purposely give false or misleading information, you may be fined, sent to prison, or both. Print Student s Name Student s Last 4 of SS# Student s Signature Date Print Parent s Name Parent s Last 4 of SS# Parent s Signature Date Page 14